Title: The new <scp>ILAE</scp> seizure classification: 63 seizure types?
Abstract: EpilepsiaVolume 58, Issue 7 p. 1298-1300 LetterFree Access The new ILAE seizure classification: 63 seizure types? Sándor Beniczky, Sándor Beniczky [email protected] Department of Clinical Neurophysiology, Aarhus University, Aarhus, Denmark Danish Epilepsy Center, Dianalund, DenmarkSearch for more papers by this authorGuido Rubboli, Guido Rubboli orcid.org/0000-0002-5309-2514 Department of Neurology, Danish Epilepsy Center, Dianalund, Denmark University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this authorHarald Aurlien, Harald Aurlien Department of Neurology, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine, University of Bergen, Bergen, NorwaySearch for more papers by this authorLawrence J. Hirsch, Lawrence J. Hirsch Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Connecticut, U.S.A.Search for more papers by this authorEugen Trinka, Eugen Trinka Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University and Center for Cognitive Neuroscience Salzburg, Salzburg, Austria Institute for Public Health, Medical Decision Making and HTA, UMIT, Hall in Tyrol, AustriaSearch for more papers by this authorDonald L. Schomer, Donald L. Schomer Department of Neurology, Laboratory of Clinical Neurophysiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, U.S.A.Search for more papers by this author on behalf of the SCORE consortium, the SCORE consortiumSearch for more papers by this author Sándor Beniczky, Sándor Beniczky [email protected] Department of Clinical Neurophysiology, Aarhus University, Aarhus, Denmark Danish Epilepsy Center, Dianalund, DenmarkSearch for more papers by this authorGuido Rubboli, Guido Rubboli orcid.org/0000-0002-5309-2514 Department of Neurology, Danish Epilepsy Center, Dianalund, Denmark University of Copenhagen, Copenhagen, DenmarkSearch for more papers by this authorHarald Aurlien, Harald Aurlien Department of Neurology, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine, University of Bergen, Bergen, NorwaySearch for more papers by this authorLawrence J. Hirsch, Lawrence J. Hirsch Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Connecticut, U.S.A.Search for more papers by this authorEugen Trinka, Eugen Trinka Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University and Center for Cognitive Neuroscience Salzburg, Salzburg, Austria Institute for Public Health, Medical Decision Making and HTA, UMIT, Hall in Tyrol, AustriaSearch for more papers by this authorDonald L. Schomer, Donald L. Schomer Department of Neurology, Laboratory of Clinical Neurophysiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, U.S.A.Search for more papers by this author on behalf of the SCORE consortium, the SCORE consortiumSearch for more papers by this author First published: 05 July 2017 https://doi.org/10.1111/epi.13799Citations: 5AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Dear Editors, We have read with great interest the ILAE position papers on the new seizure classification.1, 2 The papers nicely describe the reasoning behind the proposed new terminology of seizure types. However, not all names generated by the proposed algorithm are mentioned in the text. A detailed list with the names of all seizure types is necessary for standardization of nomenclature and communication between centers. To prevent the potential confusion generated by translation into other languages, codes attributed to each seizure type would be helpful. This became obvious when we attempted to implement the new ILAE seizure classification into the revised version of SCORE (Standardized Computer-based Organized reporting of EEG [electroencephalography])3 by a taskforce of the International Federation of Clinical Neurophysiology, comprising 39 experts. Using the reasoning described in the ILAE position papers, we propose such a list, containing 63 seizure types (Table 1). Table 1. List of seizure types according to the new ILAE seizure classification Three-step classification Name of seizure type Code Focal onset Aware Motor onset—not further specified Focal aware motor-onset seizure I.A.01 Myoclonic Focal aware myoclonic seizure I.A.02 Clonic Focal aware clonic seizure I.A.03 Tonic Focal aware tonic seizure I.A.04 Atonic Focal aware atonic seizure I.A.05 Automatisms Focal aware automatism seizure I.A.06 Hyperkinetic Focal aware hyperkinetic seizure I.A.07 Nonmotor onset—not further specified Focal aware nonmotor onset seizure I.A.08 Behavior arrest Focal aware behavior arrest seizure I.A.09 Sensory Focal aware sensory seizure I.A.10 Emotional Focal aware emotional seizure I.A.11 Cognitive Focal aware cognitive seizure I.A.12 Autonomic Focal aware autonomic seizure I.A.13 Onset not further specified Focal aware seizure I.A.14 Impaired awareness Motor onset—not further specified Focal impaired awareness motor onset seizure I.B.01 Myoclonic Focal impaired awareness myoclonic seizure I.B.02 Clonic Focal impaired awareness clonic seizure I.B.03 Tonic Focal impaired awareness tonic seizure I.B.04 Atonic Focal impaired awareness atonic seizure I.B.05 Automatisms Focal impaired awareness automatism seizure I.B.06 Hyperkinetic Focal impaired awareness hyperkinetic seizure I.B.07 Nonmotor onset—not further specified Focal impaired awareness nonmotor onset seizure I.B.08 Behavior arrest Focal impaired awareness behavior arrest seizure I.B.09 Sensory Focal impaired awareness sensory seizure I.B.10 Emotional Focal impaired awareness emotional seizure I.B.11 Cognitive Focal impaired awareness cognitive seizure I.B.12 Autonomic Focal impaired awareness autonomic seizure I.B.13 Onset not further specified Focal impaired awareness seizure I.B.14 Awareness not known or not specified Motor onset—not further specified Focal motor seizure I.C.01 Myoclonic Focal myoclonic seizure I.C.02 Clonic Focal clonic seizure I.C.03 Epileptic spasms Focal epileptic spasm I.C.04 Tonic Focal tonic seizure I.C.05 Atonic Focal atonic seizure I.C.06 Automatisms Focal automatisms seizure I.C.07 Hyperkinetic Focal hyperkinetic seizure I.C.08 Nonmotor onset—not further specified Focal nonmotor seizure I.C.09 Behavior arrest Focal behavior arrest seizure I.C.10 Sensory Focal sensory seizure I.C.11 Emotional Focal emotional seizure I.C.12 Cognitive Focal cognitive seizure I.C.13 Autonomic Focal autonomic seizure I.C.14 Onset not further specified Focal seizure I.C.15 Focal to bilateral tonic–clonic Focal to bilateral tonic–clonic seizure I.D.01 Generalized Onset Motor Onset not further specified Generalized motor seizure II.A.01 Myoclonic Generalized myoclonic seizure II.A.02 Myoclonic–atonic Myoclonic–atonic seizure II.A.04 Myoclonic–tonic–clonic Myoclonic–tonic–clonic seizure II.A.04 Clonic Generalized clonic seizure II.A.05 Epileptic spasm Generalized epileptic spasm II.A.06 Tonic Generalized tonic seizure II.A.07 Atonic Generalized atonic seizure II.A.08 Tonic–clonic Generalized tonic–clonic seizure II.A.09 Absence Typical Typical absence seizure II.B.01 Atypical Atypical absence seizure II.B.02 Myoclonic absence Myoclonic absence seizure II.B.03 Eyelid myoclonia Eyelid myoclonia with absence / without absence II.B.04 Unknown onset Motor Tonic–clonic Tonic–clonic seizure of unknown onset III.A.01 Epileptic spasm Epileptic spasm with unknown onset III.A.02 Motor—not further specified Motor seizure with unknown onset III.A.03 Nonmotor Behavior arrest Behavioral arrest with unknown onset III.B.01 Nonmotor—not further specified Nonmotor seizure with unknown onset III.B.02 Unknown Unclassified seizure III.C.01 The other practical question concerns negative myoclonus. This is not mentioned in the new classification. We were wondering what the reason could be: (1) The authors do not consider that there is evidence for such a seizure type, although several studies indicated its existence and that its correct diagnosis can have therapeutic implications4-8; (2) it should be described under myoclonic seizure types, adding "negative" in free text, as a descriptor; (3) it should be described as an atonic seizure—of very short duration. In the "Instruction manual,"2 it is stated that wherever possible, prior accepted definitions from the ILAE Glossary of 20019 were maintained, in order to support continuity of usage. Terms no longer recommended for use are omitted. The 2001 Glossary9 recognized negative myoclonus as a specific seizure type, distinct from (positive) myoclonus, and this clinical entity is commonly used in clinical practice. Therefore, it would be important to highlight its placement in the seizure classification. Disclosure None of the authors has any conflict of interest to disclose. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. References 1Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58: 522– 530. 2Fisher RS, Cross JH, D'Souza C, et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia 2017; 58: 531– 542. 3Beniczky S, Aurlien H, Brøgger JC, et al. Standardized computer-based organized reporting of EEG: SCORE. Epilepsia 2013; 54: 1112– 1124. 4Tassinari CA. New perspectives in epileptology. In Japanese Epilepsy Association (Ed) Trends in modern epileptology. Tokyo: Proceedings of the International Public Seminar on Epileptology Tokyo: Japanese Epilepsy Association, 1981: 42– 59 5Guerrini R, Dravet C, Genton P, et al. Epileptic negative myoclonus. Neurology 1993; 43: 1078– 1083. 6Tassinari CA, Rubboli G, Parmeggiani L, et al. Epileptic negative myoclonus. Adv Neurol 1995; 67: 181– 197. 7Oguni H, Uehara T, Tanaka T, et al. Dramatic effect of ethosuximide on epileptic negative myoclonus: implications for the neurophysiological mechanism. Neuropediatrics 1998; 29: 29– 34. 8Rubboli G, Mai R, Meletti S, et al. Negative myoclonus induced by cortical electrical stimulation in epileptic patients. Brain 2006; 129: 65– 81. 9Blumer WT, Luders HO, Mizrahi E, et al. Glossary of descriptive terminology for Ictal semiology: report of the ILAE task force on classification and terminology. Epilepsia 2001; 42: 1212– 1218. Citing Literature Volume58, Issue7July 2017Pages 1298-1300 ReferencesRelatedInformation